ExecTech Client - Practice Building Questionnaire
Ideally complete the form in one sitting. If you are not able to do so, you can click "Save Progress" at the bottom of the form, then choose "Skip Create an Account", then enter your email address to get your draft form sent to you for finishing later on.
Name
*
First Name
Last Name
Doctor Type (MD, DDS, DO, etc)
*
Practice Name
*
Speciality
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
1. What were your original goals for your practice?
2. Which of these goals have you achieve?
3. What are your practice goals for the next year?
4. What are your practice goals for the five years?
5. What are your practice goals for the 10 years?
6. What are your practice goals for the 20+ years?
7. If you could go back in the past and change anything about how you manage your practice, what would you change?
8. What difficulties will you need to overcome to reach these goals?
9. Of all the problems or difficulties in your practice, which are the highest priority to resolve in your viewpoint?
10. Whose advice do you seek regarding management or business issues?
11. Whose advice do you seek regarding patient care and treatment?
12. Whose advice do you seek regarding collection problems?
13. Whose advice do you seek regarding legal issues?
14. Whose advice do you seek regarding stress or personal problems?
15. What other management consulting programs have you done in the past?
16. What did they do wrong?
17. What did they do right?
18. Why did you decide to hire ExecTech?
19. How do you feel about using L. Ron Hubbard's management technology?
20. Do you anticipate any problems with your ExecTech program?
21. On a scale of 1-10 with 10 being "as much pressure as possible," how much pressure do you want your consultant and coaching to give you to complete the tasks you agree to do?
22. Will it be natural for you to call us if things are not going well?
23. Is there anything else we should know about you or your practice?
24. What, if any, questions do you have about ExecTech or your program at this time?
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